Harrow Road GP Practice, Triangle House Health Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed six quality statements in this key question. At the last inspection the practice was rated good for providing safe services. Our rating for the safe key question following this inspection is requires improvement due to concerns identified in the practice’s management of patients on repeat medication. We have asked the provider for an action plan in response to the concerns identified.

During the assessment, we reviewed policies, spoke with staff, and undertook observations while on site. The practice had systems, processes, and practices to safeguard people. Staff had the information needed to deliver safe patient care and treatment. There were arrangements for reviewing and investigating safety and safeguarding incidents and events when things go wrong.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt supported to raise concerns and felt staff treated them with compassion and understanding. Representatives from the PPG felt the provider took concerns seriously and proactively made improvements to the service.

Managers told us they encouraged staff to raise concerns when things went wrong.

Feedback from staff demonstrated that the practice had a culture of identifying incidents and complaints, learning, and improvement. Staff told us they could raise concerns and report when things went wrong. Although some said they attended meetings where significant events were discussed, some staff said they were only aware of significant events if they were directly involved. However, all staff confirmed access to the significant event log and meeting minutes, which the operations manager circulated.

The practice had a significant event and complaints policy and a reporting log accessible to all staff. Incidents were discussed during team meetings, and the learning outcomes were shared with staff. The provider had put in place a clinical governance policy and protocol, which provided guidance to clinical staff on best practices in areas such as the process for reporting clinical incidents and raising and handling safeguarding concerns.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

During this assessment, we spoke with four patients on-site. They told us they felt involved in their care and treatment.

Staff told us that patients were involved in their care and treatment. There was a balanced and proportionate approach to risk that supported people and respected the choices they made about their care. For example, managers told us people could request home visits to meet their care needs.

During our assessment we saw that people who were very unwell when they contacted the practice were prioritised. However, systems to monitor people who needed follow up were not always adequately monitored (the details of which are outlined in medicines optimisation processes).

Staff knew who the lead staff members were, such as the infection control and safeguarding leads. Leaders informed us they regularly reviewed policies, and all staff had access to them. We reviewed the minutes of the practice meetings and saw that leaders shared information and safety concerns.

We observed the facilities and equipment as well-maintained and suitable for their intended use. We saw that the practice’s equipment had been calibrated and PAT tested appropriately.

People felt they had considerate support delivered by competent people.

Staff and leaders told us staff received the support they needed to deliver safe care. This included supervision, appraisal and support to develop, improve services and where needed, professional revalidation.

Staff received training that was appropriate and relevant to their role. The provider employed an external trainer for all subjects to improve staff cohesion, increase team efficiency, and ensure staff were aligned in their understanding of the information and that the training was complete.

Patients told us the practice was always clean and well maintained.

Staff knew who the infection prevention and control lead for the practice was. Staff received training on infection prevention and control. Staff who handled clinical specimens knew how to do so safely.

The premises were visually clean, hygienic, and uncluttered. We reviewed the practice's cleaning logs, which showed regular cleaning, stock was in date and the sharps bins in clinical rooms were managed appropriately.

Policies and procedures were available to staff, which provided guidance and information on infection prevention and control (IPC) practices. Staff had completed the infection prevention and control training relevant to their role and had all undergone sepsis training. The practice had acted on the issues identified in infection prevention and control audits. The provider had an IPC lead and waste management process. An in-house survey undertaken by the practice in November 2024 found their overall IPC compliance to be 95%. The practice had sufficient waste and clinical specimen management processes.

The patients we spoke with told us they felt supported in understanding and managing any risks. Results from the practice’s latest national GP patient survey results showed that 83% of patients felt involved as much as they wanted to be in their care and treatment decisions. Additionally, 81% of GP patient survey respondents stated that during their last appointment they had confidence and trust in the healthcare professional they saw or spoke to. Both results were below the local averages. The practice’s inhouse survey questions did not align with the national GP patient survey; therefore, we were unable to compare the data between the two of them.

This evidence category was scored 1 to reflect the clinical concerns we identified within the medicines optimisation quality statement.

Clinical staff described the practice's processes to ensure appropriate clinical oversight and told us how they monitored patients' health, including their use of high-risk medicines. We found that staff had good knowledge of current and relevant best practice and professional guidance.

This evidence category was scored 1 to reflect the clinical concerns we identified within the medicines optimisation quality statement.

During the on-site inspection, we found that the fridges were monitored and recorded daily. The staff knew what to do if the fridge temperature went out of range. Emergency medicines were securely stored, accessible, and monitored for use-by dates. Staff managed medicines-related stationery appropriately and securely.

This evidence category was scored 1 to reflect the clinical concerns we identified within the medicines optimisation quality statement.

There was an effective system to evidence the competence of non-clinical medical prescribers, including clinical supervision. The practice had appropriate policies and procedures to govern prescribing effectively. The provider held regular GP clinical meetings to discuss patient cases, share knowledge about new medical information, review clinical practices, identify areas for improvement, and ultimately enhance the quality and safety of patient care within a practice. Other clinical staff were invited to the meeting when the content was deemed relevant to their roles. The practice employed an in-house psychotherapist in January 2023 to help expand the offer to patients of a non-pharmaceutical and timely pathway for presentations of low mood or feelings unhappiness. The practice had a documented referrals process to monitor the activity. All Patients named dedicated Named GP, care coordinator and pharmacist to carry out structured medication reviews and personalised support care plans on a proactive an annual basis and act as named internal points of contact on a reactive basis. There is a monthly Integrated Case Management meeting held together with the Community Matron team to proactively monitor and respond to the health and care needs of housebound patients. The process for authorising nurses to administer certain medicines was effective.

This evidence category was scored 1 to reflect the clinical concerns we identified within the medicines optimisation quality statement.

The remote clinical searches carried out by our GP specialist advisor identified areas for improvement. We found that 16 patients’ medication was not managed per NICE guidance; one of the patients was vulnerable due to their ailments and the other medications they were taking. One of the patients prescribed mirabegron (a medicine to treat the symptoms of an overactive bladder) had not had a blood pressure check for seven years. Another patient prescribed amlodipine and ramipril (a medication to treat high blood pressure) had not had a blood pressure check in four years. In two separate instances, a pharmacist and an external consultant noted that a patient required the appropriate tests to be undertaken by the practice prior to prescribing.

We also noted that two patients' HBA1c results indicated they had reached the threshold for being diabetic, but the provider had not informed them of their results as required by NICE guidance. Following the inspection, the provider emailed an action log outlining the steps taken by the practice to rectify the situation. The provider contacted each patient, booked them for tests, or scheduled a follow-up call.

The practice's outcomes for child immunisation were below the 80% expected uptake rate and the target of 95% in four of the five categories. Since March 2022, all child immunisation indicators have been on an upward trajectory in patient uptake. Their outcome for cervical cancer screening was significantly below the 80% expected rate, at 70%.

Antibiotic prescribing was in line with the local average in 5 of the 6 indicators and above the average performance in one indicator. We reviewed two clinical audits conducted by the provider within the last two years and found that they both demonstrated improvements in patient outcomes. For example, the provider increased the proportion of patients not on antidepressant medication from 45% to 60% within six months.